State's plans to overhaul health care payments could go to wire

Whether the Legislature and Gov. Deval Patrick can reach agreement on a payment reform bill remains an open question. There are three months remaining this year for the Legislature to take on controversial bills like the payment reform measure. The Senate plans a mid-May debate on a version of the bill.

Democratic legislative leaders who reviewed Gov. Deval Patrick’s sprawling health care payment reform bill for 14 months surprised Beacon Hill last week when they did not offer a redraft based on their extensive review and instead released the governor’s bill unchanged to the Senate.

Rep. Steven Walsh (D-Lynn), co-chair of the Joint Committee on Health Care Financing that had held Patrick’s bill since February 2011, told the News Service Tuesday the committee released the governor’s bill because they faced a biennial reporting deadline and the Senate asked them to release it.

“We continue to work very hard on a bill,” Walsh said. “The Senate suggested that we release the governor’s bill to them, and we acquiesced.”

Asked why the committee did not change the governor’s bill, Walsh said, “Well, according to the governor it’s because it was so perfect. We can leave it at that.”

The News Service asked Senate President Therese Murray Tuesday afternoon about Walsh’s suggestion that the committee released the governor’s bill to the Senate at her branch’s request. Murray professed surprise to hear it.

“I find that, you know, I am not going to get involved in the committee process,” Murray said. “That’s ah, the chairman I’m surprised would make a statement like that. I can’t comment on what he says.”

While his panel did not make a recommendation on Patrick’s bill, Walsh noted the committee had held five public hearings around the state, visited 53 hospitals and collected “tons of information.”

The Senate plans a mid-May debate on a version of the bill and the health care pot will be stirred June 4-6 when Patrick administration officials hold annual hearings at Bunker Hill Community College featuring sworn testimony from industry stakeholders.

Whether the Legislature and Gov. Deval Patrick can reach agreement on a payment reform bill remains an open question. There are three months remaining this year for the Legislature to take on controversial bills like the payment reform measure.

The state budget, energy system reforms, a controversial crime and sentencing bill and still-unreleased job creation legislation are among the major bills competing for the attention of legislative leaders, along with scores of less comprehensive bills as the session winds down. It’s looking more likely that if the payment reform bill is approved, it may be among a handful of major bills left to the final weeks and days of formal sessions in late July, a period prone to legislative horse-trading and similar to the chaotic end of formal sessions in July 2010 when lawmakers rubber-stamped a series of conference committee bills.

Democratic legislative leaders in recent years have with increasing frequency shown a preference for “pre-conferencing” bills, or agreeing informally on the major outlines of proposals, in bids to increase the likelihood that complex legislation will pass and not get hung up over differences between the branches.

Page 2 of 3 - While the Senate is poised to advance its own proposal, Walsh expressed confidence that the branches will be able to agree on a version of Patrick’s bill by July 31. He called the bill’s prospects “very good.”

“We have all put about 18 months into this process, and I don’t think anyone would be satisfied if there isn’t a product at the end,” Walsh said.

Last October, Walsh cautioned against the adverse consequences of advancing complex legislation too quickly but said he felt the committee was "very close" to producing a bill that they would be proud of and that Patrick would be "honored to sign." And in December 2011, Walsh said he was working with committee members every day with the goal of releasing a new version of Patrick’s bill in early 2012.

On Monday, Patrick said he had filed a “thoughtful bill.” Patrick, whose calls for action on his bill date back many months, said he was not surprised it was left untouched by the committee. “Nothing surprises me anymore,” Patrick, now in his fifth year as governor, told reporters Monday afternoon.

Sen. Richard Moore (D-Uxbridge), the Senate chair of Health Care Financing, has predicted that Patrick’s bill will undergo an extensive overhaul before the Senate Ways and Means Committee. Murray told the News Service Tuesday that the Senate bill would be released next week.

Many health care industry executives are voluntarily moving toward systems reflecting goals of payment reform – more integrated and better quality care and a movement away from the fee-for-service payment model – and lawmakers appear both hesitant to pass heavy-handed reforms and eager to see the economy-wide savings that reforms may bring to households, businesses and government itself.

A study by MIT economist Jonathan Gruber, released last week by the Blue Cross Blue Shield of Massachusetts Foundation, found workers in Massachusetts could save as much as $9,200 in take-home pay between 2011 and 2019 if health care costs grow more slowly than projected. The study found employers could save up to $34.5 billion in premium payments under that same “most aggressive” cost-saving scenario. If premiums were to rise 4 percent a year, closed to the expected growth in gross state product, workers would take home $5,800 more and employers were save $21.5 billion, the study said.

There appears to be broad agreement on the goals of curbing the soaring growth of health care costs and aligning the state's health care delivery system to incentivize healthy outcomes for patients, rather than duplicative or unnecessary testing, but the progress of a major bill of this kind can get stuck on details.

House Speaker Robert DeLeo has listed payment reform as a top priority and said last November that he planned to hold meetings with Walsh to discuss the bill, which he predicted was “probably going to be the most difficult, complex issue that we have."

Page 3 of 3 - Senate President Murray has identified high health care and energy costs are major impediments to job growth. Murray told business leaders Tuesday morning in Randolph that rate reviews and increased competition required in Senate-passed energy legislation would provide “substantial relief to businesses and consumers” and she predicted payment reform could save “tens of billions” of dollars.

“This bill will push the market to further our progress, establish independent oversight, improve the quality of care and increase the transparency and accountability of our health care providers to deliver care in the most effective and efficient way,” Murray said, according to prepared remarks for a speech to the South Shore Chamber of Commerce. “This legislation will also set a goal for reducing health care cost increases over the long-term and, if successful, the savings generated over the next ten years will be in the tens of billions.”

Murray said lawmakers are trying to balance “the need to aggressively transform the healthcare industry without causing harm to the number one employment sector in Massachusetts or to patient care.”

During a New England Cable News interview over the weekend, Murray said two laws approved since the 2006 access expansion law have allowed group purchasing cooperatives and featured other initiatives that have helped slow the growth in health care premiums.

“We have had this little hammer out there and we have been telling both providers and insurers that they have to get their costs down,” Murray said.